Retaine HPMC Lubricant Eye Drops is a preservative-free Hypromellose Ophthalmic Solution (0.3%) that provides immediate relief to soothe dry, irritated eyes by resembling natural tears, according to the company. Utilizing a patented proprietary airless pump system that prevents harmful bacteria from entering the bottle and contaminating the solution, Retaine HPMC enables delivery of multiple sterile doses to the eye without preservatives that can be damaging to the sensitive ocular surface. Most solutions intended for multiple use require the addition of preservatives, but Retaine HPMC has a three month stability after opening with guaranteed sterility.

Retaine HPMC in its multi-dose bottle allows for lower cost of treatment and is only available from OCuSOFT. Retaine HPMC joins a growing line of Retaine brand eye care products which are discounted to practitioners for direct dispensing to the patient. The program serves to not only increase practice revenues but provide added convenience and savings to patients.

For more information, call (800) 233-5469 or visit www.ocusoft.com.

Dr. Pardo brings over 17 years of ophthalmic experience to the newly formed position, including time spent in academia, various practice settings, and industry. He is a Doctor of Optometry from The New England College of Optometry, where he also did his Residency in Family Practice/Ocular Disease. He holds a Master's Degree in Public Health/Health Care Management from Yale University and Bachelor of Science degree in Biological Sciences from The State University of New York at Stony Brook. Dr. Pardo is a Fellow of the American Academy of Optometry and serves on its Membership Committee. He is also a member of the American Optometric Association and The Massachusetts Society of Optometrists. Industry experience includes time at Advanced Vision Research, J&J Vision Care/Vistakon, ISTA and Avedro, where he served in numerous executive capacities.

The TearScience in-office Dry Eye Solution includes the LipiView Ocular Surface Interferometerand LipiFlow Thermal Pulsation System along with a simplified implementation plan, effective marketing tools, and proven post-installation procedure support, providing eyecare professionals with a complete dry eye clinical and business franchise.

Xailin is a proprietary brand under which Nicox intends to commercialize a range of products for dry eye, starting with the first two products, a multi-dose preservative-free lubricating ointment for night-time relief of dry eye sensations, and a unit-dose preservative-free lubricant that alleviates and soothes dry eye sensations.

The Xailin range will include medical devices developed by Medicom Healthcare, a private UK-based pharmaceutical company specializing in ophthalmics, as per an exclusive supply and distribution agreement signed in March 2013. Nicox will launch the Xailin range of artificial tears in Europe, Middle East and Africa. Other tear lubricants are planned to be launched throughout the year 2014.

^ Back to top

There has been significant movement forward in our understanding of the roles of symptoms and objective markers in the diagnosis of dry eye disease (DED). While most patients with DED are symptomatic, many have clear objective evidence of DED while not reporting symptoms on standard questionnaires. It may be that the questionnaires don't necessarily capture symptomatology well but other studies suggest that the presence and degree of symptoms is influenced by other factors such as alterations in ocular surface sensory receptors, generalized body pain sensitivity and other central nervous system factors. Diagnosis by symptoms alone is fraught with error and this emphasizes the role of objective markers in diagnosis.

The issue is further complicated by the recent findings that the commonly used objective diagnostic markers (Schirmer, tear breakup time, corneal and conjunctival staining) do not correlate well with each other or with symptoms, particularly in patients with mild-moderate disease and are not very repeatable. This reflects that each test addresses specific effects of the disease occurring at different times and degrees in the development of disease. The variability seen is a result of the loss of homeostatic control of the tear/ ocular surface functional unit—a characteristic feature of DED. Most of the tests, however, become more consistent in more severe disease when all aspects of the ocular surface system break down. So what is a clinician to do?

In evaluating tear diagnostics, ask the following questions:

• Is it specific for DED?
• Is it repeatable?
• Is it quantitative?
• Does is reflect disease over the entire spectrum?
• Is it a marker for only one subtype of DED e.g. aqueous-tear deficiency or evaporative dry eye or is it a global measure of disease?

^ Back to top

Dry eye disease (DED) has a prevalence ranging from 7.8% to 14.6% in the United States affecting approximately 4.91 million Americans aged 50 years and older. Difficulty exists in determining the exact prevalence due to discrepancies in how DED is defined and diagnostic criteria. The goal of this study was to determine how eyecare providers are treating DED as compared with the published recommendations outlined in the 2007 DEWS report and the AAO Dry Eye PPP publication.

A 17-question online survey invitation was mailed to 400 members of the North Carolina Ophthalmology and Optometry Associations including community optometrists, comprehensive ophthalmologists, and cornea specialists. One hundred eye care providers responded that burning (46.5%) is the most frequent symptom described by patients, followed by foreign body sensation (30.3%) and tearing (17.2%). Artificial tears are the most recommended first-line treatment. Respondents reported high failure rates for both artificial tears and cyclosporine A (Restasis). The most common comorbid conditions in DED include autoimmune diseases such as rheumatoid arthritis and Sjögren's syndrome, anxiety and depression, refractive surgery, smoking, and thyroid disease. A majority of the respondents of this study didn't report their clinical practice as DED specialists, which, likely represents the “average” eye care provider. TBUT and fluorescein stain were the most frequently used clinical tests in assessing dry eye, though the majority respondents relied on patient history as the most common measure of whether therapy was effective, suggesting that current objective tools don't provide the whole clinical picture. Overall, this study revealed that the representative study group of eye care professionals has current practice patterns that largely reflect the recommendations in the DEWS report and AAO PPP document. The paper also points out that current diagnostic tools may not be sensitive to changes in treatment or changes over time, thus the reliance on subjective measures remains central to a dry eye practice

Perceptions of Dry Eye Disease Management in Current Clinical Practice
Williamson JF, Huynh K, Weaver MA, Davis RM. Eye Contact Lens. 2014 Mar;40(2):111-5.

OBJECTIVE: To assess the perceptions of eyecare providers regarding the clinical management of dry eye.

METHODS: Invitations to complete a 17-question online survey were mailed to 400 members of the North Carolina Ophthalmology and Optometry Associations including community optometrists, comprehensive ophthalmologists, and cornea specialists.

RESULTS: The survey was completed by 100 eyecare providers (25% response rate). Providers reported burning (46.5%) as the most frequent symptom described by patients, followed by foreign body sensation (30.3%) and tearing (17.2%). Most respondents (80.8%) listed artificial tears as the recommended first-line treatment, even though providers reported high failure rates for both artificial tears and cyclosporine A (Restasis). Rheumatoid arthritis, Sjögren syndrome, affective disorders such as anxiety and depression, history of photorefractive surgery, smoking, and thyroid disease were acknowledged as common comorbid conditions.

CONCLUSIONS: The survey provided an informative snapshot into the preferences of eyecare providers concerning the diagnosis and management of dry eye disease. Overall, burning was the most common symptom reported by patients. Providers relied more on patient history in guiding their clinical decisions than objective signs. The survey underscores the incongruence when comparing subjective symptoms with objective signs, thereby highlighting the urgent need for the development of reliable metrics to better quantify dry eye symptoms and also the development of a more sensitive and specific test that can be used as the gold standard to diagnose dry eye.

^ Back to top  

Coding Ancillary Dry Eye Diagnostic Procedures
Managing the ocular surface for patients is a very dynamic and exciting area of practice for today's optometrist. New technologies, such as tear film interferometry and other diagnostic tests provide new diagnostic information that just simply wasn't available on a wide scale basis a few years ago. That being said, many practitioners wonder how to properly code for the procedure or even if the diagnostic procedure is separately coded.